Medical Perspectives | Others

February 25, 2020



Doctor Jana May Marie B. Cruz, MD

I have always enjoyed going to concerts especially when it is my favorite artist or band playing. However, I just cannot help but get disappointed at the end of every show; not that the band did not perform great but because it felt like the show was on time constraint. At most, concert lasts for an hour and a half.

 

Concert goers spend money and put so much time (e.g. lining up for hours) just to see the band play but in the end, is it really worth every penny and second? Will it satisfy the “fan” in you?

 

This is comparable to when a patient visits his doctor. A patient’s visit nowadays last for only 226.8 seconds (Hood, G.A.). Exaggerated as it may sound,this is the norm now. With the pressure of having to see numbers of patients, giving them the best management possible, it is important that each visit is ended in an effective and appropriate manner. How does one actually achieve this?

 

An initial step in having a clean end in a medical visit is to start with an agenda. This can result to greater satisfaction for the physician and the patient. With this,one can prepare for a good end by starting right. Having an agenda sets the structure and time-frame of the visit. One can initially ask the patient his main reason for the visit and ask if there are other concerns he wants to add. Some patients may even have a “list” of these concerns. It is better that the physician extract all of it in the beginning. If the patient does not have other concerns, then the physician may start adding his own points and decide which to address first at the present visit and, if any, schedule other concerns in another visit. This helps avert an “Oh by the way” moment when the visit is already over.

 

After setting an agenda, let the patient tell the history of his main concern, unimpeded. Resist the temptation to interrupt, instead listen actively and encourage the patient to continue to speak. It also helps to let the patient participate dynamically to decision-making as it showed greater patient satisfaction and better health outcomes. Let the conversation flow to further understand which decisions needto be made with the patient.

 

It is also important to acknowledge the patient’s emotions as this may prolong the medical visit if not dealt with strategically. Show understanding and avoid going against the patients’ emotions due to the ticking clock on the wall.This may just cause more delay and muddle the closure. One known technique, the BATHE technique provides a structured, time-sensitive method for addressing psychosocial issues. It may be utilized at any point in a medical encounter.

 

THE BATHE TECHNIQUE

The following five-step technique is designed to help physicians uncover patients’ emotional issues quickly during an encounter. The first four letters of the BATHE acronym prompt physicians to ask questions that elicit the context for the visit. The final step is to show empathy.

  • Background: “What’s going on in your life?”
  • Affect: “How do you feel about it?” or “What has that been like for you?”
  • Troubles: “What troubles (concerns, worries) you most about it?”
  • Handling: “How are you handling (dealing with, coping with) it?”
  • Empathy: “That must be difficult for you.”

 

https://www.aafp.org/fpm/2004/...


            Do not forget to address your own emotions. As physicians, we face and develop feelings of guilt and inadequacy (often experienced by young physicians). Instead of compensating for these “feelings” by extending the time of the visit and having negative thoughts, change your thoughts to a more optimistic one and keep yourself calm. This will prevent you from feeling frustrated and discouraged.

 

            As physicians,we should also be prepared for the “oh by the way” moment known as last-minute patient complaints. Most of these issues are not emergencies.It is crucial to evaluate and classify them as emergent or non-emergent.

 

Emergent issues need to be addressed immediately (interpersonal violence or suicidal thoughts). For non-emergent issues, gently explain to the patient and in an appropriate manner that for you to be able to discuss thoroughly and give it the attention it deserves, you need to schedule another appointment. Through this, patients will learn to prioritize their concerns over time.

 

            Lastly, confirm that the objectives have been met. Always be specific when you are already about to close the session, instead of asking vaguely “Do you have any more questions?” rather “Do you have any more questions with what we have discussed today?”. Constantly keep in mind to end a visit with a smile and a handshake, make a point to use the patient’s name as you make your ending statement.

 

Being able to end medical visits in an efficient and productive approach, patients will have the assurance that they are cared for and that seeing their doctors are worth their every second.

 

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